For older Americans, the pandemic is not over yet

At the beginning of December, Aldo Caretti developed a cough and, despite all precautionary measures, tested positive for Covid in a home test. It took his family a few days to convince Mr. Caretti, who never liked doctors, to go to the emergency room. There he was transferred directly to the intensive care unit.

Mr. Caretti and his wife Consiglia, both 85, lived quietly in a condominium in Plano, Texas. “He enjoyed reading and studying, in English and Italian,” said his son Vic Caretti, 49. “He absolutely adored his three grandchildren.”

Aldo Caretti had suffered some health setbacks last year, including a minor stroke and severe shingles, but “he’s recovered from it all”.

Covid was different. Even on a ventilator, Mr. Caretti was struggling to breathe. After 10 days, “he wasn’t getting any better,” said Vic Caretti, who flew in from Salt Lake City. “His organs started to collapse. They said, ‘He’s not going to make it.’”

At least this late in the pandemic, families can be with their loved ones at the end of life. When the family agreed to remove Mr. Caretti from the ventilator and ensure comfort, “he was alert and knew very well what was happening,” his son said. “He held everyone’s hand” He died a few hours later, on December 14.

For older Americans, the pandemic still poses significant dangers. About three-quarters of Covid deaths have occurred in people over 65, with the greatest losses concentrated in those over 75.

In January, the number of Covid-related deaths fell after a holiday spike, but was still about 2,100 among those aged 65 to 74, more than 3,500 among those aged 75 to 84 and almost 5,000 among those aged 85 and over . These three groups accounted for about 90 percent of the country’s Covid deaths over the past month.

Hospital admissions, which have also declined, remain more than five times higher for people over 70 than for people in their 50s. Hospitals can put elderly patients at risk even when the conditions that brought them in are successfully treated; The harmful effects of drugs, inactivity, sleep deprivation, delirium, and other stresses can take months to recover from — or can send you back to the hospital.

“There continues to be a very high cost of Covid,” said Julia Raifman, a public health policy specialist at Boston University School of Public Health and co-author of a recent editorial in the New England Journal of Medicine.

The demographic divide reflects a debate that continues as the pandemic unfolds: What are the responsibilities of those at lower risk of the virus versus those at higher risk — not just for the elderly, but also for those who are immunocompromised or have chronic conditions Suffer?

More about the corona pandemic

• Covid vaccine mandate: New York City will end its aggressive but controversial coronavirus vaccination mandate for city workers, Mayor Eric Adams announced, signaling a pivotal moment in the city’s long fight against the pandemic.
• End of an era: The Biden administration plans to phase out the coronavirus public health emergency in May, a sign federal officials believe the pandemic has entered a new, less dire phase.
• Canceled doses: As global demand for Covid-19 vaccines dries up, the program responsible for vaccinating the world’s poor has negotiated to try to exit its deals with drug companies for vaccines it no longer needs.
• Mask Rules: Many countries dropped pandemic mask requirements months ago. But in places like South Korea, which only recently abolished its rule, masks are still common. For this reason.

Should individuals, institutions, corporations and governments maintain strategies such as masking, which help protect everyone but particularly benefit the most vulnerable?

“Are we distributing them to the whole population?” Raifman asked about these measures. “Or do we forgo it and let the shavings fall where they will?”

Nancy Berlinger, a bioethicist and research scientist at the Hastings Center, made a similar point: “The fundamental questions about ethics relate to what we owe to others, not just to ourselves, not just to our family and friends.”

Three years later, the societal response seems clear: With mask and vaccination regulations mostly over, testing centers and vaccination clinics closed, and the federal public health emergency set to expire in May, older adults are left to fend for themselves.

“Americans are divided on the duty to protect others, whether from a virus or from gun violence,” said Dr. Berlinger.

Only 40.8 percent of seniors received a bivalent booster shot. Some don’t believe they have strong protection against infection, a CDC survey reported last month (though the data indicated otherwise).

Others worry about side effects or are unsure of the effectiveness of the booster. Seniors may also have difficulty finding vaccination centers, making appointments (especially online), and traveling to vaccination centers.

In care homes where the early pandemic proved so devastating, just 52 percent of residents and 23 percent of staff were up to date on vaccinations last month. Early on, a successful federally funded campaign sent health care workers to nursing homes to administer the original vaccine doses. Medicare has also mandated staff vaccinations.

But for boosters, nursing homes were allowed to develop their own policies — or not.

“It makes absolutely no sense,” said David Grabowski, a professor of health policy at Harvard Medical School. “This is the group that should have the highest vaccination rate in the country. Everyone there is very vulnerable.”

The Covid costs for the elderly go beyond the most extreme dangers to include restricted activities, restricted lives and prolonged isolation and the risks that come with it.

In Hillsboro, Oregon, Billie Erwin, 75, feels particularly at risk because she has type 1 diabetes. She and her husband give up concerts and theater performances, dining at indoor restaurants with friends, going to the movies, and volunteering. Her book group fell apart.

“We used to spend a lot of time on the Oregon Coast,” said Ms. Erwin. But because the trip involves an overnight stay, they’ve only gone twice in three years; Annual visits to the Oregon Shakespeare Festival ended for the same reason.

The ongoing restrictions have exacerbated the depression that Ms. Erwin is also struggling with; Some days she doesn’t bother to get dressed.

“I’m disappointed that we don’t consider other people as much as we should,” she said. “I don’t know if most people even think about it.”

Eleanor Bravo, 73, who lives in Corrales, NM, lost her sister to Covid early in the pandemic; two years passed before the family could gather for a memorial service. “I had this excessive fear that if I got Covid I would die too,” Ms Bravo said.

She developed Covid in July and recovered. But she and her partner still avoid most cultural events, travel, and restaurants. “Our world has gotten a lot smaller,” she said. As an organizer at Marked by Covid, a national nonprofit, she is working to build a memorial to the 9,000 New Mexicans who have died from the virus.

Of course, many older Americans have also resumed their pre-pandemic routines. In Charlotte, NC, Donna and David Bolls, both 67, fell ill with Covid in May – “the sickest thing I can remember,” Ms Bolls said.

But after that, they returned without masks to restaurants, concerts, shopping, her part-time retail job and his church choir. “It’s a risk I’m willing to take,” she said. “I feel like I’m living my life on my terms and doing the things I want to do.”

Although the political viability of mandates for masks, vaccinations, or improved indoor air quality seems nil, policymakers and organizations could still take steps to protect the elderly (and immunocompromised) without forcing them to become recluse.

Health systems, pharmacies and government agencies could launch renewed vaccination campaigns in communities and nursing homes, including mobile clinics and home visits.

Remember the ‘senior hours’ some supermarkets introduced at the start of the pandemic to allow older customers to shop with smaller crowds and less contact? Now, “public spaces are not accessible to people concerned about infections,” said Dr. Raifman.

you could be Markets, libraries and museums could say goodbye to some mandatory mask times. Many off-Broadway theaters already schedule two or three masked performances a week; others could follow suit. Steven Thrasher, author of The Viral Underclass, organized a 20-city mask book tour last fall.

“Between the extremes of closing everything to contain transmission and doing nothing, there’s a middle ground,” said Dr. Raifman. “We can contain transmissions in an intelligent and inclusive way.”

But Vic Caretti, who has found a grief support group helpful, is drawing comments from strangers in Salt Lake City for wearing a mask in public.

“I don’t think people understand how Covid is affecting older Americans,” Caretti said, frustrated. “In 2020, there was this all-in-this-together vibe, and it was crushed. People just have to take care of others, man. This is my soap box.”